|
HC FORMALDEHYDE ALLERGY SCREEN
|
Facility
|
OP
|
$24.13
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200017
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$24.13 |
| Rate for Payer: Aetna Commercial |
$21.72
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$23.41
|
| Rate for Payer: ASR Commercial |
$23.41
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$19.76
|
| Rate for Payer: BCN Commercial |
$18.71
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cofinity Commercial |
$22.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$24.13
|
| Rate for Payer: Healthscope Whirlpool |
$23.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$21.72
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.51
|
| Rate for Payer: Nomi Health Commercial |
$19.79
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.14
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$16.92
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
OP
|
$35.37
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$35.37 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: ASR ASR |
$34.31
|
| Rate for Payer: ASR Commercial |
$34.31
|
| Rate for Payer: BCBS Complete |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$28.96
|
| Rate for Payer: BCN Commercial |
$27.42
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$35.37
|
| Rate for Payer: Healthscope Whirlpool |
$34.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.22
|
| Rate for Payer: Mclaren Commercial |
$31.83
|
| Rate for Payer: Mclaren Medicaid |
$2.80
|
| Rate for Payer: Mclaren Medicare |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$2.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: PACE Medicare |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.74
|
| Rate for Payer: PHP Medicaid |
$2.80
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.99
|
| Rate for Payer: Priority Health Medicare |
$5.22
|
| Rate for Payer: Priority Health Narrow Network |
$24.79
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.22
|
| Rate for Payer: UHC Exchange |
$8.09
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP DNSP |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$2.80
|
| Rate for Payer: VA VA |
$5.22
|
|
|
HC FORMALDEHYDE ALLERGY SCREEN REF LAB
|
Facility
|
IP
|
$35.37
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
30200125
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$35.37 |
| Rate for Payer: Aetna Commercial |
$31.83
|
| Rate for Payer: ASR ASR |
$34.31
|
| Rate for Payer: ASR Commercial |
$34.31
|
| Rate for Payer: BCBS Trust/PPO |
$28.82
|
| Rate for Payer: BCN Commercial |
$27.42
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$33.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$35.37
|
| Rate for Payer: Healthscope Whirlpool |
$34.31
|
| Rate for Payer: Mclaren Commercial |
$31.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.13
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
IP
|
$690.61
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.90 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: ASR Commercial |
$669.89
|
| Rate for Payer: BCBS Trust/PPO |
$562.78
|
| Rate for Payer: BCN Commercial |
$535.43
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$690.61
|
| Rate for Payer: Healthscope Whirlpool |
$669.89
|
| Rate for Payer: Mclaren Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL 1
|
Facility
|
OP
|
$690.61
|
|
| Hospital Charge Code |
45000044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$276.24 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$621.55
|
| Rate for Payer: Aetna Medicare |
$345.30
|
| Rate for Payer: ASR ASR |
$669.89
|
| Rate for Payer: ASR Commercial |
$669.89
|
| Rate for Payer: BCBS Complete |
$276.24
|
| Rate for Payer: BCBS Trust/PPO |
$565.54
|
| Rate for Payer: BCN Commercial |
$535.43
|
| Rate for Payer: Cash Price |
$552.49
|
| Rate for Payer: Cofinity Commercial |
$649.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.49
|
| Rate for Payer: Healthscope Commercial |
$690.61
|
| Rate for Payer: Healthscope Whirlpool |
$669.89
|
| Rate for Payer: Mclaren Commercial |
$621.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.02
|
| Rate for Payer: Nomi Health Commercial |
$566.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$605.11
|
| Rate for Payer: Priority Health Narrow Network |
$484.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$607.74
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
OP
|
$3,041.50
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,216.60 |
| Max. Negotiated Rate |
$3,041.50 |
| Rate for Payer: Aetna Commercial |
$2,737.35
|
| Rate for Payer: Aetna Medicare |
$1,520.75
|
| Rate for Payer: ASR ASR |
$2,950.26
|
| Rate for Payer: ASR Commercial |
$2,950.26
|
| Rate for Payer: BCBS Complete |
$1,216.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,490.68
|
| Rate for Payer: BCN Commercial |
$2,358.07
|
| Rate for Payer: Cash Price |
$2,433.20
|
| Rate for Payer: Cofinity Commercial |
$2,859.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.20
|
| Rate for Payer: Healthscope Commercial |
$3,041.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,950.26
|
| Rate for Payer: Mclaren Commercial |
$2,737.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,585.28
|
| Rate for Payer: Nomi Health Commercial |
$2,494.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,664.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,132.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,676.52
|
|
|
HC FRACTURE/DISLOCATION TX LEVEL II
|
Facility
|
IP
|
$3,041.50
|
|
| Hospital Charge Code |
45000104
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,976.98 |
| Max. Negotiated Rate |
$3,041.50 |
| Rate for Payer: Aetna Commercial |
$2,737.35
|
| Rate for Payer: ASR ASR |
$2,950.26
|
| Rate for Payer: ASR Commercial |
$2,950.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,478.52
|
| Rate for Payer: BCN Commercial |
$2,358.07
|
| Rate for Payer: Cash Price |
$2,433.20
|
| Rate for Payer: Cofinity Commercial |
$2,859.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,433.20
|
| Rate for Payer: Healthscope Commercial |
$3,041.50
|
| Rate for Payer: Healthscope Whirlpool |
$2,950.26
|
| Rate for Payer: Mclaren Commercial |
$2,737.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,585.28
|
| Rate for Payer: Nomi Health Commercial |
$2,494.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,676.52
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
OP
|
$438.60
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$30.57 |
| Max. Negotiated Rate |
$438.60 |
| Rate for Payer: Aetna Commercial |
$394.74
|
| Rate for Payer: Aetna Medicare |
$57.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.30
|
| Rate for Payer: ASR ASR |
$425.44
|
| Rate for Payer: ASR Commercial |
$425.44
|
| Rate for Payer: BCBS Complete |
$32.10
|
| Rate for Payer: BCBS MAPPO |
$57.04
|
| Rate for Payer: BCBS Trust/PPO |
$359.17
|
| Rate for Payer: BCN Commercial |
$340.05
|
| Rate for Payer: BCN Medicare Advantage |
$57.04
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$412.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.04
|
| Rate for Payer: Healthscope Commercial |
$438.60
|
| Rate for Payer: Healthscope Whirlpool |
$425.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$57.04
|
| Rate for Payer: Mclaren Commercial |
$394.74
|
| Rate for Payer: Mclaren Medicaid |
$30.57
|
| Rate for Payer: Mclaren Medicare |
$57.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.89
|
| Rate for Payer: Meridian Medicaid |
$32.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: Nomi Health Commercial |
$359.65
|
| Rate for Payer: PACE Medicare |
$54.19
|
| Rate for Payer: PACE SWMI |
$57.04
|
| Rate for Payer: PHP Commercial |
$62.74
|
| Rate for Payer: PHP Medicaid |
$30.57
|
| Rate for Payer: PHP Medicare Advantage |
$57.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.61
|
| Rate for Payer: Priority Health Medicare |
$57.04
|
| Rate for Payer: Priority Health Narrow Network |
$74.09
|
| Rate for Payer: Railroad Medicare Medicare |
$57.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.04
|
| Rate for Payer: UHC Exchange |
$88.41
|
| Rate for Payer: UHC Medicare Advantage |
$57.04
|
| Rate for Payer: UHCCP DNSP |
$57.04
|
| Rate for Payer: UHCCP Medicaid |
$30.57
|
| Rate for Payer: VA VA |
$57.04
|
|
|
HC FRAGILEX ANALYSIS
|
Facility
|
IP
|
$438.60
|
|
|
Service Code
|
CPT 81243
|
| Hospital Charge Code |
31000099
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$285.09 |
| Max. Negotiated Rate |
$438.60 |
| Rate for Payer: Aetna Commercial |
$394.74
|
| Rate for Payer: ASR ASR |
$425.44
|
| Rate for Payer: ASR Commercial |
$425.44
|
| Rate for Payer: BCBS Trust/PPO |
$357.42
|
| Rate for Payer: BCN Commercial |
$340.05
|
| Rate for Payer: Cash Price |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$412.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$350.88
|
| Rate for Payer: Healthscope Commercial |
$438.60
|
| Rate for Payer: Healthscope Whirlpool |
$425.44
|
| Rate for Payer: Mclaren Commercial |
$394.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.81
|
| Rate for Payer: Nomi Health Commercial |
$359.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.97
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
IP
|
$257.04
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.08 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Commercial |
$231.34
|
| Rate for Payer: ASR ASR |
$249.33
|
| Rate for Payer: ASR Commercial |
$249.33
|
| Rate for Payer: BCBS Trust/PPO |
$209.46
|
| Rate for Payer: BCN Commercial |
$199.28
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$241.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Healthscope Commercial |
$257.04
|
| Rate for Payer: Healthscope Whirlpool |
$249.33
|
| Rate for Payer: Mclaren Commercial |
$231.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$210.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.20
|
|
|
HC FRAGILE X FOLLOW UP
|
Facility
|
OP
|
$257.04
|
|
|
Service Code
|
CPT 81244
|
| Hospital Charge Code |
30000113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$257.04 |
| Rate for Payer: Aetna Commercial |
$231.34
|
| Rate for Payer: Aetna Medicare |
$44.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.11
|
| Rate for Payer: ASR ASR |
$249.33
|
| Rate for Payer: ASR Commercial |
$249.33
|
| Rate for Payer: BCBS Complete |
$25.26
|
| Rate for Payer: BCBS MAPPO |
$44.89
|
| Rate for Payer: BCBS Trust/PPO |
$210.49
|
| Rate for Payer: BCN Commercial |
$199.28
|
| Rate for Payer: BCN Medicare Advantage |
$44.89
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cash Price |
$205.63
|
| Rate for Payer: Cofinity Commercial |
$241.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.89
|
| Rate for Payer: Healthscope Commercial |
$257.04
|
| Rate for Payer: Healthscope Whirlpool |
$249.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$44.89
|
| Rate for Payer: Mclaren Commercial |
$231.34
|
| Rate for Payer: Mclaren Medicaid |
$24.06
|
| Rate for Payer: Mclaren Medicare |
$44.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.13
|
| Rate for Payer: Meridian Medicaid |
$25.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.48
|
| Rate for Payer: Nomi Health Commercial |
$210.77
|
| Rate for Payer: PACE Medicare |
$42.65
|
| Rate for Payer: PACE SWMI |
$44.89
|
| Rate for Payer: PHP Commercial |
$49.38
|
| Rate for Payer: PHP Medicaid |
$24.06
|
| Rate for Payer: PHP Medicare Advantage |
$44.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.59
|
| Rate for Payer: Priority Health Medicare |
$44.89
|
| Rate for Payer: Priority Health Narrow Network |
$23.67
|
| Rate for Payer: Railroad Medicare Medicare |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.89
|
| Rate for Payer: UHC Exchange |
$69.58
|
| Rate for Payer: UHC Medicare Advantage |
$44.89
|
| Rate for Payer: UHCCP DNSP |
$44.89
|
| Rate for Payer: UHCCP Medicaid |
$24.06
|
| Rate for Payer: VA VA |
$44.89
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
OP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$56.00
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.46
|
| Rate for Payer: ASR ASR |
$60.35
|
| Rate for Payer: ASR Commercial |
$60.35
|
| Rate for Payer: BCBS Complete |
$10.56
|
| Rate for Payer: BCBS MAPPO |
$18.77
|
| Rate for Payer: BCBS Trust/PPO |
$50.95
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: BCN Medicare Advantage |
$18.77
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$58.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.77
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Whirlpool |
$60.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$18.77
|
| Rate for Payer: Mclaren Commercial |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$10.06
|
| Rate for Payer: Mclaren Medicare |
$18.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.71
|
| Rate for Payer: Meridian Medicaid |
$10.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| Rate for Payer: PACE Medicare |
$17.83
|
| Rate for Payer: PACE SWMI |
$18.77
|
| Rate for Payer: PHP Commercial |
$20.65
|
| Rate for Payer: PHP Medicaid |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$18.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.52
|
| Rate for Payer: Priority Health Medicare |
$18.77
|
| Rate for Payer: Priority Health Narrow Network |
$43.62
|
| Rate for Payer: Railroad Medicare Medicare |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.77
|
| Rate for Payer: UHC Exchange |
$29.09
|
| Rate for Payer: UHC Medicare Advantage |
$18.77
|
| Rate for Payer: UHCCP DNSP |
$18.77
|
| Rate for Payer: UHCCP Medicaid |
$10.06
|
| Rate for Payer: VA VA |
$18.77
|
|
|
HC FREE FATTY ACIDS
|
Facility
|
IP
|
$62.22
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
30100201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Aetna Commercial |
$56.00
|
| Rate for Payer: ASR ASR |
$60.35
|
| Rate for Payer: ASR Commercial |
$60.35
|
| Rate for Payer: BCBS Trust/PPO |
$50.70
|
| Rate for Payer: BCN Commercial |
$48.24
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cofinity Commercial |
$58.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Healthscope Commercial |
$62.22
|
| Rate for Payer: Healthscope Whirlpool |
$60.35
|
| Rate for Payer: Mclaren Commercial |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.89
|
| Rate for Payer: Nomi Health Commercial |
$51.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.75
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
OP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$7.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.14
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.29
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$7.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Mclaren Medicaid |
$3.92
|
| Rate for Payer: Mclaren Medicare |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Meridian Medicaid |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: PACE Medicare |
$6.94
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$8.04
|
| Rate for Payer: PHP Medicaid |
$3.92
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.09
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Priority Health Narrow Network |
$46.48
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.31
|
| Rate for Payer: UHC Exchange |
$11.33
|
| Rate for Payer: UHC Medicare Advantage |
$7.31
|
| Rate for Payer: UHCCP DNSP |
$7.31
|
| Rate for Payer: UHCCP Medicaid |
$3.92
|
| Rate for Payer: VA VA |
$7.31
|
|
|
HC FREE PLASMA HEMOGLOBIN
|
Facility
|
IP
|
$66.30
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
30100240
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: ASR ASR |
$64.31
|
| Rate for Payer: ASR Commercial |
$64.31
|
| Rate for Payer: BCBS Trust/PPO |
$54.03
|
| Rate for Payer: BCN Commercial |
$51.40
|
| Rate for Payer: Cash Price |
$53.04
|
| Rate for Payer: Cofinity Commercial |
$62.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.04
|
| Rate for Payer: Healthscope Commercial |
$66.30
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| Rate for Payer: Mclaren Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.36
|
| Rate for Payer: Nomi Health Commercial |
$54.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.34
|
|
|
HC FRENOTOMY
|
Facility
|
IP
|
$1,991.76
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,294.64 |
| Max. Negotiated Rate |
$1,991.76 |
| Rate for Payer: Aetna Commercial |
$1,792.58
|
| Rate for Payer: ASR ASR |
$1,932.01
|
| Rate for Payer: ASR Commercial |
$1,932.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,623.09
|
| Rate for Payer: BCN Commercial |
$1,544.21
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cofinity Commercial |
$1,872.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Healthscope Commercial |
$1,991.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,932.01
|
| Rate for Payer: Mclaren Commercial |
$1,792.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: Nomi Health Commercial |
$1,633.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,752.75
|
|
|
HC FRENOTOMY
|
Facility
|
OP
|
$1,991.76
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
36100471
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$777.91 |
| Max. Negotiated Rate |
$2,249.56 |
| Rate for Payer: Aetna Commercial |
$1,792.58
|
| Rate for Payer: Aetna Medicare |
$1,451.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: ASR ASR |
$1,932.01
|
| Rate for Payer: ASR Commercial |
$1,932.01
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,631.05
|
| Rate for Payer: BCN Commercial |
$1,544.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cash Price |
$1,593.41
|
| Rate for Payer: Cofinity Commercial |
$1,872.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,593.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Healthscope Commercial |
$1,991.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,932.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,451.33
|
| Rate for Payer: Mclaren Commercial |
$1,792.58
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,693.00
|
| Rate for Payer: Nomi Health Commercial |
$1,633.24
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Commercial |
$1,596.46
|
| Rate for Payer: PHP Medicaid |
$777.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,745.18
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,396.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,752.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$2,249.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP DNSP |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$777.91
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
IP
|
$5,700.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$3,705.00 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: ASR ASR |
$5,529.00
|
| Rate for Payer: ASR Commercial |
$5,529.00
|
| Rate for Payer: BCBS Trust/PPO |
$4,644.93
|
| Rate for Payer: BCN Commercial |
$4,419.21
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cofinity Commercial |
$5,358.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Healthscope Commercial |
$5,700.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,529.00
|
| Rate for Payer: Mclaren Commercial |
$5,130.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: Nomi Health Commercial |
$4,674.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,016.00
|
|
|
HC FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$5,700.00
|
|
|
Service Code
|
CPT 54164
|
| Hospital Charge Code |
76100429
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Aetna Commercial |
$5,130.00
|
| Rate for Payer: Aetna Medicare |
$2,007.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: ASR ASR |
$5,529.00
|
| Rate for Payer: ASR Commercial |
$5,529.00
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,667.73
|
| Rate for Payer: BCN Commercial |
$4,419.21
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cash Price |
$4,560.00
|
| Rate for Payer: Cofinity Commercial |
$5,358.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$5,700.00
|
| Rate for Payer: Healthscope Whirlpool |
$5,529.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,007.09
|
| Rate for Payer: Mclaren Commercial |
$5,130.00
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.00
|
| Rate for Payer: Nomi Health Commercial |
$4,674.00
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$2,207.80
|
| Rate for Payer: PHP Medicaid |
$1,075.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,705.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,994.34
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$3,995.70
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,016.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,110.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP DNSP |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: VA VA |
$2,007.09
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
OP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$365.05 |
| Rate for Payer: Aetna Commercial |
$328.54
|
| Rate for Payer: Aetna Medicare |
$82.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: ASR ASR |
$354.10
|
| Rate for Payer: ASR Commercial |
$354.10
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$298.94
|
| Rate for Payer: BCN Commercial |
$283.02
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$343.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$365.05
|
| Rate for Payer: Healthscope Whirlpool |
$354.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.59
|
| Rate for Payer: Mclaren Commercial |
$328.54
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: Nomi Health Commercial |
$299.34
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$90.85
|
| Rate for Payer: PHP Medicaid |
$44.27
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.59
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$94.87
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$128.01
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP DNSP |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$44.27
|
| Rate for Payer: VA VA |
$82.59
|
|
|
HC FRESH FROZEN PLASMA
|
Facility
|
IP
|
$365.05
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000051
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$237.28 |
| Max. Negotiated Rate |
$365.05 |
| Rate for Payer: Aetna Commercial |
$328.54
|
| Rate for Payer: ASR ASR |
$354.10
|
| Rate for Payer: ASR Commercial |
$354.10
|
| Rate for Payer: BCBS Trust/PPO |
$297.48
|
| Rate for Payer: BCN Commercial |
$283.02
|
| Rate for Payer: Cash Price |
$292.04
|
| Rate for Payer: Cofinity Commercial |
$343.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.04
|
| Rate for Payer: Healthscope Commercial |
$365.05
|
| Rate for Payer: Healthscope Whirlpool |
$354.10
|
| Rate for Payer: Mclaren Commercial |
$328.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.29
|
| Rate for Payer: Nomi Health Commercial |
$299.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$321.24
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
IP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.27 |
| Max. Negotiated Rate |
$268.11 |
| Rate for Payer: Aetna Commercial |
$241.30
|
| Rate for Payer: ASR ASR |
$260.07
|
| Rate for Payer: ASR Commercial |
$260.07
|
| Rate for Payer: BCBS Trust/PPO |
$218.48
|
| Rate for Payer: BCN Commercial |
$207.87
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$252.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$268.11
|
| Rate for Payer: Healthscope Whirlpool |
$260.07
|
| Rate for Payer: Mclaren Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.94
|
|
|
HC FRESH FROZEN PLASMA 2X
|
Facility
|
OP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000052
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$268.11 |
| Rate for Payer: Aetna Commercial |
$241.30
|
| Rate for Payer: Aetna Medicare |
$82.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: ASR ASR |
$260.07
|
| Rate for Payer: ASR Commercial |
$260.07
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$219.56
|
| Rate for Payer: BCN Commercial |
$207.87
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$252.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$268.11
|
| Rate for Payer: Healthscope Whirlpool |
$260.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.59
|
| Rate for Payer: Mclaren Commercial |
$241.30
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$90.85
|
| Rate for Payer: PHP Medicaid |
$44.27
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.59
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$94.87
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$128.01
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP DNSP |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$44.27
|
| Rate for Payer: VA VA |
$82.59
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
OP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$44.27 |
| Max. Negotiated Rate |
$268.11 |
| Rate for Payer: Aetna Commercial |
$241.30
|
| Rate for Payer: Aetna Medicare |
$82.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.24
|
| Rate for Payer: ASR ASR |
$260.07
|
| Rate for Payer: ASR Commercial |
$260.07
|
| Rate for Payer: BCBS Complete |
$46.48
|
| Rate for Payer: BCBS MAPPO |
$82.59
|
| Rate for Payer: BCBS Trust/PPO |
$219.56
|
| Rate for Payer: BCN Commercial |
$207.87
|
| Rate for Payer: BCN Medicare Advantage |
$82.59
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$252.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$268.11
|
| Rate for Payer: Healthscope Whirlpool |
$260.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$82.59
|
| Rate for Payer: Mclaren Commercial |
$241.30
|
| Rate for Payer: Mclaren Medicaid |
$44.27
|
| Rate for Payer: Mclaren Medicare |
$82.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.72
|
| Rate for Payer: Meridian Medicaid |
$46.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: PACE Medicare |
$78.46
|
| Rate for Payer: PACE SWMI |
$82.59
|
| Rate for Payer: PHP Commercial |
$90.85
|
| Rate for Payer: PHP Medicaid |
$44.27
|
| Rate for Payer: PHP Medicare Advantage |
$82.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.59
|
| Rate for Payer: Priority Health Medicare |
$82.59
|
| Rate for Payer: Priority Health Narrow Network |
$94.87
|
| Rate for Payer: Railroad Medicare Medicare |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.59
|
| Rate for Payer: UHC Exchange |
$128.01
|
| Rate for Payer: UHC Medicare Advantage |
$82.59
|
| Rate for Payer: UHCCP DNSP |
$82.59
|
| Rate for Payer: UHCCP Medicaid |
$44.27
|
| Rate for Payer: VA VA |
$82.59
|
|
|
HC FRESH FROZEN PLASMA 2X CMPT
|
Facility
|
IP
|
$268.11
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
39000050
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.27 |
| Max. Negotiated Rate |
$268.11 |
| Rate for Payer: Aetna Commercial |
$241.30
|
| Rate for Payer: ASR ASR |
$260.07
|
| Rate for Payer: ASR Commercial |
$260.07
|
| Rate for Payer: BCBS Trust/PPO |
$218.48
|
| Rate for Payer: BCN Commercial |
$207.87
|
| Rate for Payer: Cash Price |
$214.49
|
| Rate for Payer: Cofinity Commercial |
$252.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.49
|
| Rate for Payer: Healthscope Commercial |
$268.11
|
| Rate for Payer: Healthscope Whirlpool |
$260.07
|
| Rate for Payer: Mclaren Commercial |
$241.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.89
|
| Rate for Payer: Nomi Health Commercial |
$219.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.94
|
|
